Whenever most prospective dental students interview for placement into the dental schools of their choice, they usually cite their desire to “help people” as their motivation for pursuing a career in dentistry. So, why have so many non-dentists entered into the profession? Is it their altruistic desire to “help people,” or is it something a bit more self-serving?

The average person reading this article might initially be unsympathetic to the plight of the dentist, as some in the general population have liken dentists to used-car salesmen. Sorry. No offense to used-car salesmen. Several commentaries about the profession have asserted the position that many people feel that most dentists overcharge, and as a result, they have a mistrust of dentists. Oftentimes, that mistrust usually originates from misinformation, and sometimes, misrepresentation of information from the individuals’ insurance companies and human resources managers. However, that’s another topic entirely.

To completely understand any argument made on behalf of the dentist, it’s important to understand the dentists’ perspective. To begin, the cost of dental education has skyrocketed over the past few decades. According The America Dental Education Association (ADEA), the average debt for graduating dental students, based on a survey of the class of 2016, is $261,149. However, based on the average cost of dental school tuition, I believe that number should be a lot higher. Listed below is a compilation of the tuitions for a few schools in major metropolitan areas. The amounts stated are solely tuition, unless otherwise stated, and does not include additional fees, including instrument fees, states/local fees, books fees or living expenses.

University

State

In-State Tuition Per Year

Out-of-State Tuition Per Year

LECOM School of Dental Medicine

Florida

$49,700

Nova Southeastern University College of Dentistry

Florida

$62,350

University of Maryland School of Dentistry

Maryland

$17,681.50

$32,864.50

University of Mississippi Medical Center School of Dentistry

Mississippi

$26,800

Not provided on website

Columbia University College of Dental Medicine

New York

$72,378

New York University College of Dentistry

New York

$72,904

Boston University Henry M Goldman School of Dentistry

Massachusetts

$72,000

University of California, Los Angeles School of Dentistry

California

$43,278.37 (*tuition and total mandatory fees)

The University of Texas Health Science Center San Antonio

Texas

$24,150 (tuition only)

$38,446 (tuition and fees)

*Tuition rates are cited from the College/University websites

Keep in mind that these aggregate costs, which, in many cases, are upwards of a quarter of a million dollars, are solely for dental school tuition. These moneys do not include tuition affiliated with other undergraduate or post-baccalaureate degrees or certificate programs that individuals might have sought in preparation for admission into these colleges. Additionally, the tuitions do not include the additional costs associated with specialty programs that could take an additional two to six years, depending on the specialty program. That in itself is egregious! What’s even more egregious is that many graduating dentist are being squeezed from both ends-going in and coming out. That brings me to the argument against corporate dentistry.

Many individuals affiliated with corporate dental franchises have not assumed any of the risks associated with the profession. However, they are gainfully partaking in the monetary rewards. One of the unfortunate sides of corporate dentistry is that some companies do not pay their associates a traditional salary. Many dentists are compensated based on commission or a “draw,” which could essentially be compared to a pay advanced loan. For example, if a company agrees to compensate an individual at a rate of $100/day and that individual only earns $80, the company will pay the individual the $100 and the individual will be in the hole for $20, which would be taken from the next pay day, assuming that the individual’s production is above the stated production goal. The problem with that form of compensation is that, as time progresses, it could become dicey and convoluted, especially when third-party payers are involved. Imagine trying to keep track of a year’s worth of earnings.

Aside from tuition, there are several financial obligations associated with the dental profession. Initial state licensure could cost several thousand dollars and require periodic renewal. Malpractice insurance is also a fundamental part of any dentist’s armamentarium. Additionally, most dentists participate in routine, continuing education courses to maintain their license and advance their knowledge. To be fair, many corporate dental practices do assume the cost of providing malpractice insurance coverage and continuing education costs. However, these companies do have a disproportionate advantage over individuals who have made a sacrificial commitment to the profession. Sole proprietorship, which is one of several reasons why many have chosen a career in dentistry over medicine, is being threatened, if not obliterated, by corporate dentistry. Individuals who are saddled by six-figure debt might not be financially prepared or able to compete in the marketplace.

Speaking of marketplace, many Internet sites have ranked dentistry as one of the highest paying profession with starting salaries of over $100,000. In addition to the private practice arena, the profession of dentistry does offer a variety of areas of practice, including academia, federally qualified health centers and research facilities, just to name a few. However, the prevalence of those additional opportunities does not change the fact that corporate dental companies have dramatically impacted and influenced the private sector of dentistry. Additionally, a six-figure salary scaled against and even larger six-figure debt might be more of a risk than a reward for some. In fact, the larger the salary, the larger the tax implications and the smaller the adjusted gross income, which could make repayment of student loans an overwhelming obstacle to the dentist’s success and independence.

So, where does that leave the fate of the profession? The truth is, corporate dentistry is hear to stay, and it is not the only variable impacting the dental profession, as evidence by the increasing dental school tuition rates. These additional variables, which also include the impending burst of the student loan bubble, are multifactorial and beyond the scope of this article. Nonetheless, corporate dental practices are growing at a rapid pace. However, that growth could be brought to a screeching halt in the near future. Life is a balance of risks and rewards, and if future practitioners determine that the risks are greater than the rewards, there could be a decline in the dental school matriculation rate, and hence, the amount of people entering the profession. I guess we will just have to wait and see.